Benjain A Beristain

Individual provider Active NPI Registered Nurse · Flossmoor, IL

NPI 1285282178 · NPPES record last updated Sep 3, 2019

Key facts

NPI
1285282178
Entity type
Individual (NPI type 1)
Primary specialty
Registered Nurse 163W00000X
License
041.481623 (IL)
Practice address
3015 Harolds Cres
Flossmoor, IL 60422-2009
Phone
(708) 420-6057
NPI assigned
Sep 3, 2019
Sex
Male
Sole proprietor
No

Organizations & group practices 1

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

Medicare participation

Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

Medicare enrollment (NPD)
No

State licenses

LicenseStateTypeSpecialty
041.481623ILMDRegistered Nurse

Practice roles

OrganizationSpecialtyStatusNew patients
Bottles to Spoons, Inc. Registered Nurse Past
since Sep 8, 2019
Accepting new patients

Specialties & licenses

Specialty (taxonomy)CodeLicenseStatePrimary
Registered Nurse 163W00000X 041.481623 IL Yes

Addresses

Primary practice location

3015 Harolds Cres
Flossmoor, IL 60422-2009

Mailing address

5217 W Cornelia Ave
Chicago, IL 60641-3305
Phone (773) 908-3219

Other providers in Flossmoor, IL

All providers in Flossmoor, IL · Registered Nurse in Illinois

Sources for this page

Verify at the official NPI Registry.